----- Original Message -----
From: "Paul Glasziou" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, March 03, 2006 8:45 AM
Subject: Best EBM methods papers for 2005?
> Dear All,
> What do you think were the best EBM methods papers of last year? To
> start the ball rolling, here are my two favourites: the first is now
> our best evidence that EBM works (the E for EBM), and the second is a
> major improvement in the "clinical queries" filters we use in PubMed.
>
> 1. Straus SE, Ball C, Balcombe N, Sheldon J, McAlister FA. Teaching
> evidence-based medicine skills can change practice in a community
> hospital. J Gen Intern Med. 2005 Apr;20(4):340-3.
> OBJECTIVES: Several studies have evaluated whether evidence-based
> medicine (EBM) training courses can improve skills such as literature
> searching and critical appraisal but to date, few data exist on
> whether teaching EBM skills and providing evidence-based resources
> result in change in behavior or clinical outcomes. This study was
> conducted to evaluate whether a multifaceted EBM intervention
> consisting of teaching EBM skills and provision of electronic
> evidence resources changed clinical practice. DESIGN: Before/after
> study. SETTING: The medical inpatient units at a district general
> hospital. PARTICIPANTS: Thirty-five attending physicians and 12
> medicine residents. INTERVENTION: A multicomponent EBM intervention
> was provided including an EBM training course of seven 1-hour
> sessions, an EBM syllabus and textbook, and provision of
> evidence-based resources on the hospital network. MEASUREMENTS AND
> MAIN RESULTS: The primary outcome of the study was the quality of
> evidence in support of therapies initiated for the primary diagnoses
> in 483 consecutive patients admitted during the month before and the
> month after the intervention. Patients admitted after implementation
> of the EBM intervention were significantly more likely to receive
> therapies proven to be beneficial in randomized controlled trials
> (62% vs 49%; P= .016). Of these trial-proven therapies, those offered
> after the EBM intervention were significantly more likely to be based
> on high-quality randomized controlled trials (95% vs 87%; P= .023).
> CONCLUSIONS: A multifaceted intervention designed to teach and
> support EBM significantly improved evidence-based practice patterns
> in a district general hospital.
>
> 2. Haynes RB, McKibbon KA, Wilczynski NL, Walter SD, Werre SR; Hedges
> Team. Optimal search strategies for retrieving scientifically strong
> studies of treatment from Medline: analytical survey. BMJ. 2005 May
> 21;330(7501):1179. Epub 2005 May 13.
> OBJECTIVE: To develop and test optimal Medline search strategies for
> retrieving sound clinical studies on prevention or treatment of
> health disorders. DESIGN: Analytical survey. DATA SOURCES: 161
> clinical journals indexed in Medline for the year 2000. MAIN OUTCOME
> MEASURES: Sensitivity, specificity, precision, and accuracy of 4862
> unique terms in 18 404 combinations. RESULTS: Only 1587 (24.2%) of
> 6568 articles on treatment met criteria for testing clinical
> interventions. Combinations of search terms reached peak
> sensitivities of 99.3% (95% confidence interval 98.7% to 99.8%) at a
> specificity of 70.4% (69.8% to 70.9%). Compared with best single
> terms, best multiple terms increased sensitivity for sound studies by
> 4.1% (absolute increase), but with substantial loss of specificity
> (absolute difference 23.7%) when sensitivity was maximised. When
> terms were combined to maximise specificity, 97.4% (97.3% to 97.6%)
> was achieved, about the same as that achieved by the best single term
> (97.6%, 97.4% to 97.7%). The strategies newly reported in this paper
> outperformed other validated search strategies except for two
> strategies that had slightly higher specificity (98.1% and 97.6% v
> 97.4%) but lower sensitivity (42.0% and 92.8% v 93.1%). CONCLUSION:
> New empirical search strategies have been validated to optimise
> retrieval from Medline of articles reporting high quality clinical
> studies on prevention or treatment of health disorders.
>
> Can you let us all know your favourites of 2005?
> Best wishes,
>
> Paul Glasziou
> Department of Primary Health Care &
> Director, Centre for Evidence-Based Practice, Oxford
> ph: 44-1865-227055
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